Wang et al modified the Child-Turcotte-Pugh (CTP) score by adding blood ammonia as an additional parameter (designated aCTP). The authors are from Nanjing University in China.
Patient selection: cirrhosis
Parameters:
(1) serum total bilirubin
(2) serum albumin
(3) prothrombin time
(4) grade of hepatic encephalopathy
(5) ascites
(6) plasma ammonia
Parameter
Finding
Points
total bilirubin
< 2 mg/dL
1
2 – 3 mg/dL
2
> 3 mg/dL
3
serum albumin
> 3.5 g/dL
1
2.8 – 3.5 g/dL
2
< 2.8 g/dL
3
prothrombin time, in seconds prolonged
1 – 4 seconds prolonged
1
4 – 6 seconds prolonged
2
> 6 seconds prolonged
3
grade of hepatic encephalopathy
none
1
grade 1 or 2
2
grade 3 or 4
3
ascites
none
1
mild
2
severe, tense
3
ammonia
< upper limit of normal (ULN)
1
1 to 1.39 times ULN
2
>= 1.4 times ULN
3
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 6
• maximum score: 18
Total Score
Class
Transplant Free Survival at 60 Months
6
A
73%
7 to 9
B
54%
>= 10
C
30%
Performance:
• The c-statistic was 0.75.
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